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NURS 6512 :Cardiovascular System

The patient is dealing with a major cardiovascular issue based on the case study. All the
current medication prescribed to the patient needs to be reviewed for appropriate changes.
Cardiovascular disease counts as a major cause of disability and leads to a cause of death
globally. The statistic indicates that approximately a person dies within approximately 36
seconds in the United States due to cardiovascular disease (Benjamin et al., 2019). Therefore,
cardiovascular disease is the major cause of health disparities and increases the cost of health
care. It is vital to consider the patient's lifestyle, history, and review to manage HH's illness
effectively. This paper addresses the factors that influence a patient's pharmacokinetics and
pharmacodynamics process and gives changes that impact the recommended drug therapy.
Factor Influencing Pharmacokinetic and Pharmacodynamics Process in the Patient
Based on the case study, the factor that I have selected is age, which can lead to drug
toxicity and influence the pharmacokinetics of different medications. Age causes an increase in
the altered metabolism and blood concentration of drugs (Giri et al., 2018). A decrease in renal
function causes an alteration of drug pharmacokinetics such as glomerular filtration rate and
reduces blood flow. Age-related changes that occur in a patient include physiological factors and
temperature (Giri et al., 2018). The physiological factors cognition, ventricular aerial stiffness,
endothelial function, and electric conduction (Rosenthal & Burchum, 2021). Most people are
sensitive to antihypertensive medication due to sympathetic neuronal and baroreceptor response
(Giri et al., 2018).
Glipizide is used to cure an adult with type 2 diabetes mellitus. The drug effectively
promotes insulin release from the beta cells since it reduces glucose output from the liver

(Addul-Ghani et al., 2021). For patients with inadequate metabolic control, the combination of
metformin and Glipizide helps reach the goal of HbA1c within three months (Addul-Ghani et al.,
2021). Glipizide is effective since it has a short life and effect duration, thus lowering the risk of
long-lasting hypoglycemia (Addul-Ghani et al., 2021). Patients taking Glipizide with thyroid
hormone, estrogen-containing contraceptives, thiazide diuretics, nicotinic acid, and calcium
channel blockers have a high potential for hyperglycemia (Rosenthal & Burchum, 2021).
Metformin effectively improves glycemic control, which takes place without inducing
hypoglycemia or causing obesity, thus considered a first-line pharmacologic treatment (Shurrab
& Arafa, 2020). The drug inhibits gluconeogenesis by causing a block on the mitochondrial
redox shuttle, thus acting in the liver (Shurrab & Arafa, 2020). Metformin is identified to cause
gastrointestinal adverse effects such as nausea, diarrhea, and vomiting (Shurrab & Arafa, 2020).
FDA labels warn against prescribing Metformin drug therapy for patients with acute heart failure
when supplemented with hypoxemia and hypoperfusion.
Hydrochlorothiazide (HCTZ) is used to treat hypertension since it is a thiazide-type
diuretic (Rosenthal & Burchum, 2021). The drug inhibits the sodium chloride co-transparent
system leading to the distal of the convoluted tubules (Rosenthal & Burchum, 2021). A lower
level of blood pressure is achieved due to the diuretic action. However, studies have declined
hydrochloride as an ACE inhibitor for reducing the risk of cardiovascular disease (Handelsman
et al., 2020). The adverse effect caused by the use of hydrochlorothiazide is the development of
hyperglycemia (Rosenthal & Burchum, 2021). The drug therapy effectively manages latent
diabetes and causes an increase in triglycerides and cholesterol (Rosenthal & Burchum, 2021).
The combination of HCTZ with calcium channel blockers and ACE inhibitors effectively
reduces hypertension.

Atenolol acts as a beta blocker that causes an effect on blood circulation and the heart.
The drug helps treat hypertension and angina, effectively bind the beta-1 adrenergic receptors in
the vascular smooth muscle (Habib et al., 2021). This affects the chronotropic actions of the
endogenous catecholamine. The process leads to a decrease in myocardial contractility heart rate
and lowers blood pressure. The drug therapy is limited for a patient with moderate severely
impaired renal (Habib et al., 2021). The side effects of Atenolol use include causing weight gain
and heart failure for some patients.
Hydralazine drug causes direct relaxation of the arteriolar smooth muscle. This is
considered an antihypertensive agent and phthalazine derivative (Sangshetti et al., 2019). A
reverse antihypertensive effect is likely to be experienced due to vasodilation (Sangshetti et al.,
2019). This is caused by hydralazine followed by a reflex sympathetic response. The drug
therapy is effective when combined with isosorbide dinitrate in reducing hypertension. The side
effects of using hydralazine cause a lupus-like syndrome in rare cases. However, the drug leads
to discontinuation of the drug (Sangshetti et al., 2019).
Simvastatin is used as an adjunct to diet thus used as an oral HMG-CoA reductase
inhibitor. A patient using Simvastatin gain a reduction in dyslipidemia and a decline in
cholesterol production (Di Bello et al., 2020). The cholesterol synthesis is catalyzed by
converting HMC-CoA to mevalonate, completely inhibited by hepatic hydroxymethyl-glutaryl
coenzyme A (HMG-CoA) reductase (Di Bello et al., 2020). The agent effectively reduces the
lipoprotein level and lowers the plasma cholesterol. The side effect of using Simvastatin 80mg is
that it has a higher risk of possible rhabdomyolysis and myopathy after 12 months of use (Di
Bello et al., 2020).

Verapamil is used to treat hypertension, atrial tachyarrhythmia, and angina pectoris and is
classified in the class of calcium channel blockers. It helps block the cardiac muscle cells and
influx of calcium ions into the vascular smooth muscle in the membrane depolarization (Savage
et al., 2020). The action helps in decreasing the oxygen consumption and the cardiac work. The
drug is also effective in causing a reduction in atrial–ventricular conduction. This helps in
controlling the supraventricular tachyarrhythmia (Savage et al., 2020). The side effect of using
verapamil include causing transient serum enzyme elevation to be mild to moderate and the liver
injury from mild (Savage et al., 2020).

Improving Drug Therapy Plan

The patient can experience congestive heart failure (CHF) when there is a combination of
verapamil, atenolol, and Hydrochlorothiazide (HCTZ) (Rosenthal & Burchum, 2021). For
effective control of stroke, it is important to control blood pressure. It is important to avoid
duplicitous therapy, which causes harm. Interaction between verapamil and Simvastatin leads to
an increase in the blood level of Simvastatin (Di Bello et al., 2020). The act leads to kidney
damage and rhabdomyolysis and causing liver damage. Atenolol can cause an increase in the
duration of hypoglycemic symptoms along with Glipizide (Habib et al., 2021).


It is important to ensure that a patient is educated on the need to consider frequent blood
glucose monitoring. This is a result of atenolol due to the symptom of hypoglycemia. The
symptom of hypoglycemia include heart palpitations, rapid heartbeat, and tremor (Rosenthal &
Burchum, 2021).



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DeFronzo, R. A. (2021). Durability of triple combination therapy versus stepwise
addition therapy in patients with new-onset T2DM: 3-year follow-up of EDICT. Diabetes
care, 44(2), 433-439. https://diabetesjournals.org/care/article-abstract/44/2/433/35501
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., …
& American Heart Association Council on Epidemiology and Prevention Statistics
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mediated physiological alteration and metabolic distortion leads to organ dysfunction,
infection, cancer progression and other pathophysiological consequences: an update on
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Habib, S., Alam, M., Mustafa, M., & Verma, A. K(2021). Role of Beta-Blockers as an Effective
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and Hypertension. https://www.researchgate.net/profile/Abhishek-Kumar-Verma-
Handelsman, Y., Jellinger, P. S., Guerin, C. K., Bloomgarden, Z. T., Brinton, E. A., Budoff, M.
J., … & Wyne, K. L. (2020). Consensus statement by the American association of clinical
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Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's Pharmacotherapeutics for Advanced
Practice Nurses and Physician Assistants. Elsevier.
Sangshetti, J., Pathan, S. K., Patil, R., Ansari, S. A., Chhajed, S., Arote, R., & Shinde, D. B.
(2019). Synthesis and biological activity of structurally diverse phthalazine derivatives: A
systematic review. Bioorganic & Medicinal Chemistry, 27(18), 3979-3997.
Savage, R. D., Visentin, J. D., Bronskill, S. E., Wang, X., Gruneir, A., Giannakeas, V., … &
McCarthy, L. M. (2020). Evaluation of a common prescribing cascade of calcium
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